To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

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It is never a good idea to self-diagnose and treat urine incontinence.
At the very least, you should see your doctor for a checkup once a year.
You must follow your doctor's instructions for any treatment.
You should only order repeat supplies of medicines that your doctor has prescribed.

Do you require assistance?

Do you require assistance?

Severe gastrointestinal issues (such as Crohn's disease and ulcerative colitis)
Ectopic pregnancy, fallopian tube surgery, or pelvic inflammatory illness.
Do you require assistance?


Your symptoms are becoming more severe.
After seven days of medication, the symptoms have not improved.
Continuous rectal bleeding, dark or sticky feces, stomach pain, or sudden weight loss are all symptoms you're experiencing.



Antibiotics.
Antihistamines such as stemizole or terfenadine.
Cisapride for stomach discomfort.
Quinidine for circulatory problems.
Pimozide for schizophrenia.

A healthcare practitioner should assess any acute injuries.
You should see your doctor about chronic pain at least once a year.

You have or have had stomach or duodenal ulcers, as well as stomach or intestinal bleeding in the past.
Your doctor has ever told you that your kidney function is less than 100 percent.
You have previously suffered a terrible reaction to aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).
You want to use Ibuprofen Gel on skin that is fractured, injured, diseased, or infected.

Please select your option
Male
Female

Please select your option
Presently Pregnant
Presently Breastfeeding
Planning on getting pregnant
Planning on Becoming Pregnant
Neither Pregnant nor Breastfeeding

Please provide more information of the medication being used if any.

You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function


Crohn's disease or ulcerative colitis are examples of small bowel diseases.
An ectopic pregnancy history.
Salpingitis in the past (inflammation of the Fallopian tubes).

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Please speak to your pharmacist if you require further counselling



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Please write below any further information which may be relevant e.g. medicines, conditions...




Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

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- You declare that I have answered the above truthfully- You will read the patient information leaflet before taking your medication (if prescribed)- You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment- You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health- You understand that this questionnaire is part of a request to the doctor and the final decision will rest with the doctor